Utilization Review Specialist
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Job Location:
Las Vegas, NV - USA
Hourly Salary:
USD 18 - 22
Posted on:
2 days ago
Vacancies:
1 Vacancy
Job Summary
ABOUT US:
Ethos Risk Services is a leading insurance claims investigation and medical management company committed to providing better data that translates into better decision-making for our clients. We are at the forefront of innovation in our space and our success is driven by a dynamic team passionate about delivering exceptional services to our customers.
JOB SUMMARY:
Our Ethos Medical Management Team is seeking a full-time Utilization Review Specialist (REMOTE) to play a key role in ensuring the efficient accurate and timely processing of Utilization Management and Independent Review requests for our clients. This role involves reviewing case requests maintaining compliance with applicable regulations supporting Physician Advisors with case materials and scheduling and delivering exceptional client service through phone and email communication.
KEY RESPONSIBILITIES:
- Review and process Independent Review (IR) requests for potential conflicts of interest.
- Request and organize additional medical documentation for Physician Advisors.
- Schedule peer-to-peer calls as needed.
- Ensure all work meets Client State Federal and URAC compliance standards.
- Maintain the security and confidentiality of Protected Health Information (PHI).
- Provide timely professional client service via phone and email.
- Adhere to company policies procedures and turnaround time expectations.
QUALIFICATIONS:
Education: High school diploma or equivalent required.
Experience:
- Minimum of 1 year in a healthcare-related setting (required).
- Knowledge of HIPAA rules and regulations required.
- Prior experience in utilization review medical management or insurance preferred.
Skills:
- Proficiency in Microsoft Office Suite (Word Excel Outlook).
- Excellent written and verbal communication skills.
- Strong attention to detail and organizational abilities.
- Customer service mindset with professional phone etiquette.
WORKING CONDITIONS:
This position is 100% remote requiring standard business hours of 8:00 AM to 5:00 PM Pacific Standard Time (PST). If youre located in another time zone you must be able to adjust your schedule to align with PST hours including occasional flexibility to start earlier or work later as needed. Candidates should have a dedicated workspace with reliable high-speed internet. The role involves extended periods of sitting frequent computer use and regular communication via phone email and other digital platforms.
Ethos Risk Services is an equal opportunity employer that does not discriminate on the basis of religious creed sex national origin race veteran status disability age marital status color or sexual orientation or any other characteristic.
Required Experience:
IC
Key Skills
- Sales Experience
- Crane
- Customer Service
- Communication skills
- Heavy Equipment Operation
- Microsoft Word
- Case Management
- OSHA
- Team Management
- Catheterization
- Microsoft Outlook Calendar
- EHS
About Company
Verify Your Claims With Absolute Certainty Verification is tough when you can’t be sure. Speed up your resolution with accurate and actionable insights. Talk to Us Assign a Case More Coverage All 50 states & 80+ countries. Get the results and help you need no matter where your claim t ... View more
